Purpose or Case Report: In this education exhibit we will review a variety of presentations of posttransplant lymphoproliferative disorder (PTLD) and review the approach to imaging these patients. We will include cases that are atypical and discuss the pitfalls in imaging this population. We will provide imaging guidelines after a review of the current literature.
Methods & Materials: Posttransplant lymphoproliferative disorder (PTLD) is a serious complication following 10-20% of patients following transplant. Most cases of pediatric PTLD area associated with the Epstein Barr Virus (EBV) in this immunosuppressed population. Pathologic classification of PTLD lesions range from uncontrolled proliferation of the B lymphocytes to invasive malignant lymphoma. In recent years, the complications from PTLD have decreased due to improved surveillance and earlier diagnosis.
Results: A multimodality approach with contrast enhanced computed tomography (CECT), magnetic resonance imaging (MRI) and positron emission tomography (PET/CT) is used in the diagnosis and surveillance of treatment response in patients with PTLD. The most common sites of PTLD remain the tonsils, cervical nodes, gastrointestinal tract and the chest. Extrathoracic PTLD tends to present later than intrathoracic PTLD. PTLD typically occurs within the allograft organ itself, as well as in the adjacent anatomic regions. However, this is not true after heart transplantation. The imaging appearance of PTLD is often times non-specific and can overlap with opportunistic infections leading to diagnostic pitfalls.
A variety of clinical treatment options exist, including reduction of immunosuppression, anti-CD20 monoclonal antibodies, alpha-interferon and chemotherapy. Furthermore, antiviral and early detection measures are being used to prevent disease and improve outcomes.
Conclusions: PTLD is a perplexing entity in the pediatric post-transplant population requiring multidisciplinary involvement. Early recognition of symptoms, knowledge of the classic as well as atypical imaging presentations and basic understanding of the multimodality use of the Radiology service will allow referring clinicians to cater and optimize treatment for the best outcomes.